Government Records Branch of North Carolina

One of North Carolina's earliest health laws was an act of the 1755 Assembly ordering quarantine on vessels "to prevent malignant and infectious Distempers being spread by Shipping importing [sic] distempered Persons into this Province." Although this act was repealed by the 1760 Assembly, other maritime quarantine laws were introduced and amended by later assemblies.

In 1802 the General Assembly empowered the Commissioners of Navigation in the various seaports to appoint port physicians and to assist the justices of the peace in enforcing maritime quarantine laws. Throughout much of the nineteenth century, the legislature continued the practice of appointing special commissioners to oversee the operation of other health laws but made no provision for a state agency to promote and enforce public health laws.

Following the Civil War, many states established boards of health that eventually evolved into modern public health agencies. North Carolina followed suit in 1877 when the General Assembly constituted the entire membership of the Medical Society of North Carolina as the State Board of Health. The Medical Society accepted the state's challenge and planned to appoint an executive committee to act on behalf of the board. In its enabling act, the State Board of Health was charged with caring for the health of the citizenry by investigating the sanitary and environmental conditions related to the causes and prevention of disease, especially epidemics, and with disseminating information on health matters to the public. The board was to report its activities and recommendations to the governor and through him to the legislature. County medical societies affiliated with the State Medical Society were to be constituted as county boards of health and placed under the general direction of the State Board of Health. The proposed cooperation between the state and county boards was intended to create a uniform system of health and sanitation throughout the state.

However, the General Assembly appropriated only one hundred dollars to establish this health system; and the existence of the State Board of Health was nominal. In 1879 the General Assembly reconstituted the state board with provisions that six of its nine members were to be elected by ballot of the Medical Society from among its active membership and that three members, including a civil engineer, were to be appointed by the governor. Gubernatorial appointees were to serve two-year terms, along with two of the Medical Society representatives. Of the remaining representatives, two were to serve terms of four years, and two were to serve terms of six years. The state board was to elect a president for a two-year term and a secretary-treasurer for a six- year term, with the latter officer also functioning as a salaried chief administrator.

An important innovation in the 1879 act was the requirement that each county establish an auxiliary board of health and each board elect a local physician to serve as superintendent of health. The secretary of the state board was charged with maintaining a supply of fresh vaccine viruses for issuance to the county superintendents in the event of an outbreak of small pox, and the county superintendents were required to vaccinate all who applied, all prisoners, inmates of public institutions, and school children. The state board also was charged with investigating outbreaks of diseases and issuing informational bulletins to help prevent or to check the spread of diseases. County superintendents were charged with performing autopsies, attending to the health needs of prisoners and inmates of public institutions, and collecting vital have local unsanitary nuisances corrected. In the event of epidemics in the port areas, the state and local boards were to render all possible aid to assist the quarantine officers.

In 1881 the General Assembly enacted legislation intended to insure the annual registration of vital statistics through the state board. This act required persons listing their taxable property with the county to fill out an additional form prepared and furnished by the state board, in order to capture information such as marital status, births and deaths, causes of death, and infectious disease within the family. However, this registration system does not appear to have been implemented. In 1885 the General Assembly extended printing privileges to the State Board of Health, and the next year they began publication of THE HEALTH BULLETIN. This journal became a widely distributed and important part of the board's mission to advise and educate.

By the early 1890s, the Medical Society and the county superintendents of health were advocating stronger public health laws. The state board responded by calling for a general health conference to convene in Raleigh in January 1893 and to involve officials of state, county, and municipal governments, as well as physicians, lawyers, merchants, and other prominent citizens. The conference produced a bill that was presented to the General Assembly and was subsequently passed.

The public health law of 1893 was a milestone in providing citizens with better protection against contagious diseases and generally strengthening regulations both at the local and the state levels. The duties of the state board were expanded to include annual inspection of all public institutions, including the State Penitentiary and convict camps under state jurisdiction. The state board was charged with ascertaining that inland waters were safe sources of domestic water supply, and with advising institutions, towns, and corporations regarding sanitary treatments of water supplies and sewage. Local officials were obligated to submit plans for treatment plants to the state board for approval. The state board was also authorized to regulate common carriers that transported infected persons or the bodies of those who had died of an infectious disease. During epidemics, the state board was authorized to issue regulations to protect the public health in all areas of the state lacking organized local boards of health and to impose penalties as necessary, enforcable by local justices of the peace. By the same law, the composition of the state board was changed to five gubernatorial appointees and four appointees of the Medical Society. Terms of the latter group were reduced to two years to correspond with those of the governor's appointees.

In separate legislation, the 1893 General Assembly appropriated funds to establish the North Carolina Station for Maritime Sanitation. The president and secretary of the State Board of Health were made ex officio members of the quarantine board in charge of the facility. The state board and the governor were both authorized to disburse funds for operation of the station.

During the last decade of the century, the state board was beginning to develop into the statewide system envisioned by its early leaders. Standing committees gradually evolved into the following bureaus: Epidemics and its subdivision, Water Supply and Drainage; Hygienics of Public Schools; Climatology; Adulteration of Food and Medicines; Sanitary Conditions of State Institutions; and Vital Statistics.

In 1899 the General Assembly passed additional legislation to protect public water supplies from contamination, and the State Board of Health was charged with instructing local health boards and water company inspectors on the procedures for sampling and inspection. All suppliers of public water were required to adhere to standards and regulations established by the state board, and each watershed used as a water supply was to be inspected no less frequently than every three months. In 1903 the General Assembly directed the state board to superintend monthly biological analyses and quarterly chemical analyses of each public water supply, including watersheds. Under the law, all field inspectors were required to distribute information on sanitation as supplied by the municipal health officers or the state board.

In 1905 the General Assembly established a State Laboratory of Hygiene under the authority of the State Board of Health. With a legislative appropriation of only six hundred dollars, the state lab required financial assistance from the Department of Agriculture to perform such functions as testing and analyzing samples from public water supplies and other sources significant in the maintenance of public health. In 1907 the General Assembly stipulated that each water company pay an annual fee, whether or not analyses of its water were conducted by the state lab. This income, combined with legislative appropriations, made it possible to reorganize the lab and to secure a full-time director in 1908 under the supervision of the State Board of Health. In separate legislation, the 1907 legislature authorized the board to offer preventive treatment of rabies, providing free services to those unable to pay. Costs were to be met by the occasional transfer of funds from the state lab.

In the same year, the General Assembly appropriated funds for the establishment of the North Carolina Sanatorium for the Treatment of Tuberculosis. The sanatorium was opened in 1908 in an area now known as McCain in Cumberland County (reformed as Hoke County in 1911). Administration of the facility was first vested in a board of directors composed of twelve members appointed by the governor and the secretary of the State Board of Health. In 1913, the sanatorium was placed under the jurisdiction of the State Board of Health; tuberculosis was designated a reportable disease; and a Bureau of Tuberculosis was established under the state board to monitor the state's tubercular population, to encourage methods for obtaining cures, and to curb the spread of the disease.

The legislature stipulated in 1909 that the president of the State Board of Health be elected from the membership of the board to serve for six years and that the secretary be elected from and by the registered physicians of the state, also for a term of six years. Under the law, the secretary was designated by the new title of state health officer and was required to devote full time to public health work.

Several months after the installation of the first state health officer, philanthropist John D. Rockefeller donated one million dollars to a campaign to eradicate hookworm disease in the South. In 1910 an assistant secretary was appointed to the state board to direct a Hookworm Commission, also known as the North Carolina Campaign Against Hookworm Disease. Subsequently, the state board formed the Bureau of Hookworm Eradication to continue the efforts of the campaign. The bureau placed a director and assistant in each rural community to examine its residents, treat those infected, and insure that residents maintained sanitary privies and reduced soil pollution. These efforts proved successful in reducing the incidence of the disease and exemplified a more modern approach to county health work.

In legislation enacted in 1911 the General Assembly recognized the State Board of Health as the state's medical adviser and directed it to make recommendations about sanitation in all matters concerning the locating, construction, and management of state institutions. The state board was also required to issue bulletins statewide in the event of a dangerous outbreak of disease. By the same law, the terms of state board members were increased to six years, and one of the governor's appointees was required to be a sanitary engineer. To support these expanded duties, the state board established a Bureau of Sanitary Engineering and Education.

The 1911 public health law provided that county sanitary committees be granted the status of local boards of health and accorded greater regulatory authority. (In 1901 the General Assembly had replaced the county boards of health with sanitary committees.) Consisting of the chairman of the county commissioners, the mayor of the county seat, the county superintendent of schools, and two physicians, the local board was required after 1913 to hire either a full-time county health officer, or a part-time physician who treated patients in local institutions. To support their work at the state level, the State Board of Health established a unit called the Bureau of County Health Work.

In 1913 the General Assembly enacted a law providing for the statewide registration of births and deaths, including information on the causes of deaths. Based on a model prepared by the U.S. Bureau of the Census, the 1913 law represented a substantial strengthening of one passed in 1909 requiring towns with populations of one thousand or more to submit reports of vital statistics. (The 1909 law had been followed so inconsistently that the Bureau of the Census would not accept North Carolina as a reliable source of statistics until 1916 for deaths and 1917 for births.) The 1913 law provided for a central Bureau of Vital Statistics under the jurisdiction of the State Board of Health, with the secretary of the board serving as the state registrar of vital statistics. With the establishment of the bureau, over a thousand local registrars were appointed by county commissioners.

The Bureau of Hookworm Sanitation was terminated by the state board in 1915, but its work was continued by the Bureau of Rural Sanitation. The bureau encouraged county boards to solve their own rural sanitation problems. However, counties that could not afford a full-time health officer could contrct with the state board to assist in introducing the principles of health and sanitation to the area and in promoting measures to reduce the incidence of specific infectious diseases, such as typhoid fever.

In 1917 an administrative reorganization by the State Board of Health resulted in three new divisions: a Bureau of Epidemiology, which was responsible for the control of communicable diseases; a Bureau of Medical Inspection of Schools, which worked with school officials primarily through a nursing staff; and a Bureau of Life Extension, whose work was discontinued later that year when its director left for military service.

The Bureau of Medical Inspection of Schools soon identified poor dental health as the most prevalent health problem among school children. Lectures and oral hygiene demonstrations were introduced in public schools throughout the state, and volunteer dentists organized portable clinics in schools or other facilities. In 1918 the State Board of Health also established a Bureau of Venereal Diseases, financed through federal funds. The Bureau of Infant Hygiene, established about this time and reorganized in 1918 as the Bureau of Public Health Nursing and Infant Hygiene, was funded equally by the state and the American Red Cross.

In 1917 the General Assembly also charged the state board with responsibility for the sanitary conditions and the hygienic care of prisoners in state prisons, local jails, county prison camps, and all other places of confinement. Previously, the state board had only been responsible for annual inspections and for making recommendations on sanitation.

In 1919 the General Assembly authorized the state board to regulate the construction and maintenance of privies and to establish an inspection system to enforce minimum standards. The Bureau of Sanitary Engineering and Inspection, which superseded the Bureau of Engineering and Education, was to recommend types of privies suitable to the variety of geomorphic conditions found in the state, including the location of watersheds; to inspect, license, and close privies if necessary in accord with the board's regulations; to make other sanitation inspections; to assist in the enforcement of public health laws, particularly quarantine and vital statistics laws; and to collect samples from public water supplies for analysis by the State Laboratory of Hygiene. Later, the 1927 General Assembly created a system of sanitary districts to be supervised and advised by the state board with the support of the Bureau of Sanitary Engineering.

In 1922 the Bureau of Public Health Nursing and Infant Hygiene was reorganized as the Bureau of Maternity and Infancy. The majority of its support was from federal funds approved for the promotion of the welfare of mothers and infants.

In 1923 the General Assembly transferred control of the North Carolina Sanatorium for the Treatment of Tuberculosis from the State Board of Health to its own independent governing board composed of gubernatorial appointees. The state board continued to support the work of the state's sanitoriums, however, and particularly through public education and articles in the HEALTH BULLETIN.

The 1923 General Assembly also enacted a law to improve the sanitary conditions under which bedding materials were manufactured and to regulate their marketing practices. Subsequently, the state board established a unit to administer the law. The General Assembly of 1937 provided for collection of revenue to go into the Bedding Law Fund for related administrative costs.

In 1930 Governor O. Max Gardner engaged the Brookings Institution of Washington, D.C., to analyze the workings of state government, including the State Board of Health, and to recommend improvements to the 1931 General Assembly. During that period the board underwent various organizational and administrative changes, including consolidation and renaming major programs as divisions instead of bureaus. Among the immediate changes, the Division of County Health Work and Epidemiology was formed from two previously separate bureaus, and it was eventually renamed the Division of Epidemiology. The most dramatic change occurred when the 1931 General Assembly abolished the state board and terminated the service of all board members. Terms of the state health officer and a new board were set at four years, and board terms were staggered to end at two-year intervals. Unexpired terms could no longer be filled by the board; the governor and the executive committee of the Medical Society would fill unexpired terms among their respective appointees. The selection of the state health officer could become effective only after approval by the governor, and the term of service was limited to four years.

In 1931 the dental care program was established as a separate Division of Oral Hygiene and expanded its efforts to educate the public preventive dental care. In the early 1930s the Division of Preventive Medicine took responsibility for school health services, health education and information, and maternal and child health services. Later in the decade, they initiated a nutrition program offering consultation services to local health departments, schools, and other institutions requesting services.

In 1935 the state board established a Division of Industrial Hygiene using allocations from both the General Assembly and the U.S. Public Health Sesrvice. The division worked cooperatively with the North Carolina Industrial Commission, the state's administrator of the federal workmen's compensation law, and by 1936 was actively involved in the study of occupational diseases, including those caused by dust particles, attempting to devise ways of reducing environmental hazards.

During the 1930s the Division of Epidemiology expanded its programs in several new areas. In 1936 the division began to emphasize the control of malaria by encouraging accurate reporting of the disease, identifying high incidence areas, supporting the drainage of swamps in those areas, and promoting community wide sanitation projects financed by Works Progress Administration (WPA) funds. The division also stressed the control of syphilis, an effort stimulated by an annual donation of one hundred thousand dollars for ten years from the Reynolds Foundation and a grant from the U.S. Public Health Service. Toward the end of the decade, a new section of the division was established to promote the detection and treatment of venereal disease, and treatment clinics were established in participating counties.

In April 1936 the state board established a diagnosis and treatment service for crippled children under the Division of Preventive Medicine, with funds primarily derived from the federal Children's Bureau and Social Security appropriations. Within several years, there were monthly clinics throughout the state to diagnose and register cases. Funds were for general hospital care and treatment, convalescent care, and the purchase of orthopedic appliances. The program worked in cooperation with other state hospitals, particularly with the North Carolina Orthopedic Hospital in Gastonia. By 1944 almost 20,000 crippled children had been registered.

In 1937 the General Assembly authorized the state board to issue revenue bonds to be used for expansion of the State Laboratory of Hygiene. With the aid of a federal Public Works Administration grant and assistance from the WPA, the board began construction of a new lab and acquisition of a farm for maintaining animals used in the production of smallpox vaccine, antitoxins, and the like. The new lab was occupied in 1940, just in time to meet increased demands for its services.

Successive legislatures during the 1930s and 1940s passed laws that expanded the duties of the state board, primarily in areas administered by the Division of Sanitary Engineering. In 1937 the General Assembly enacted a law requiring the board to establish sanitation rules for fresh meat markets. Local inspectors were required to file reports with the local health officer, or with the state health officer if there was no local health officer. The legislature in 1939 required the state board to establish a system of inspection and approval of used plumbing fixtures and in 1941 required the state board, instead of the insurance commissioner, to enforce all state building code provisions not otherwise covered by local ordinances or rules and regulations of the county health board. The same year, the state board was required to oversee sanitation inspections of bus stations and to file reports and recommendations with station managers, bus companies, and the Utilities Commission.

Entry of the United States into World War II in 1941 had widespread effects on state and local public health efforts. Fort Bragg was greatly enlarged and military camps and other installations established. Generally, health programs gave increased attention to the prevention of infectious disease epidemics. At the same time, maternal and child health, school health, communicable disease control, industrial hygiene, and other essential programs were contineud and in some instances expanded. The Division of Sanitary Engineering was expanded to reflect advances in the field of milk sanitation, shellfish sanitation, restaurant sanitation, and stream pollution abatement. Also, the number of local health departments increased to a total of eighty- four out of one hundred counties.

In a meeting in May 1944 the state board authorized the creation of a Bureau of Tuberculosis Control, formally reviving the board's historic involvement in efforts to control the disease. However, appropriations from federal and state sources were insufficient to operate a separate bureau. The program merged briefly with the Division of Industrial Hygiene, which had operated a pilot program for tuberculosis control with assistance from the U.S. Public Health Service. In 1945 the General Assembly funded the tuberculosis program and authorized the state board to supervise any federal tuberculosis programs conducted in the state. The program was subsequently placed in the new Tuberculosis Control Section of the Division of Epidemiology. The section provided nursing consultation and public education, but emphasized detection of active cases by means of patient chest x-ray surveys conducted by various county health departments.

In 1945 the General Assembly established a Stream Sanitation and Conservation Study Committee with the directory of the Division of Sanitary Engineering as its chairman. Its ex officio members included the state health officer. Although previous legislatures had granted the State Board of Health authority in protection of public water supplies, it was increasingly apparent that the state should consider protection of all streams, particularly from pollution by industrial waste discharges.

Also in 1945, the General Assembly instructed the state board to initiate a program related to the prevention and cure of cancer, with emphasis on the early detection and treatment of cancers. Under terms of the law, the board was to provide a system of financial aid for low-income cancer patients; establish minimum standards for cancer clinics or departments in general hospitals; collect information on cancer and sponsor an educational program for citizens; and compile and preserve statistical, clinical, and other records relating to cancer prevention and cure. This program was placed administratively in the Division of Epidemiology.

In October 1945 the Bureau of Vital Statistics was combined with the Division of Epidemiology, and the function of recording births and deaths was placed administratively under the Vital Statistics Section. The work of that section was expanded to include the collection of data on the incidence of tuberculosis, cancer, venereal disease, and acute communicable diseases. During this period of functional expansion for the state board, the 1945 General Assembly changed the composition of the board by requiring that the gubernatorial appointees include a registered pharmacist, a reputable dairyman, and a food processor or server.

At a meeting of the state board in May 1949, the state health officer reported that Governor Kerr Scott had designated the board as the official state agency administrator of the state's Mental Hygiene Program. In July of that year the State Mental Health Authority was transferred from the Hospitals Board of Control to the State Board of Health, and the state board formed a Mental Health Section as program administrator under the Division of Local Health.

By the mid-twentieth century the state had reached a turning point in its public health programs. In 1949 the last remaining county established a full-time health department. During that year the General Assembly increased its appropriations to the state board, which were enhanced significantly by matching funds from the Reynolds Foundation. In 1950 the state health officer completed an administrative reorganization of the board, with the result that some former divisions were absorbed into the remaining divisions and reestablished as sections. The major divisions were then as follows: the Division of Epidemiology, including sections of Public Health Statistics, Communicable Diseases, Venereal Diseases, Tuberculosis, Industrial Hygiene; the Division of Personal Health, (formerly Preventive Medicine), including sections of Maternal and Child Health, Crippled Children, Nutrition, Cancer, and Heart Disease; the Division of Sanitary Engineering, including sections of Sanitation, Environmental, Public Eating Places, Milk, Bedding, Shellfish, Engineering, and Stream Sanitation; the Division of Local Health, including sections of School Health, Public Health Nursing, Mental Health, and Health Education; Oral Hygiene, including sections of Visual Education, Consultation, Correction, and Prevention; the Division of Laboratories, including services in microscopy, cultures, serology, and water chemistry; and Administrative Services, which included sections of Public Information, Film Library, and Public Health Library.

During the course of administrative reorganization, several new programs emerged within the state board including the Accident Prevention Section of the Division of Epidemiology. A special study during the early 1950s found death from accidental causes as the state's third leading cause of death. The board applied to the Kellogg Foundation, and was awarded ninety-eight thousand dollars to study the problem in depth and to formulate a statewide program of accident prevention. In July 1951 a section of Veterinary Public Health was established under the Division of Epidemiology to eradicate or control animal diseases that were considered transmittable to humans. During the same year a unit on malaria control, formerly under the Division of Epidemiology, was transferred to the Division of Sanitary Engineering and incorporated into a new Insect and Rodent Control Section. During the same period, the Maternal and Child Health Section of the Personal Health Division instituted a program intended to reduce the mortality rate of premature infants.

In 1951 the General Assembly revised state laws on stream sanitatation and initiated a comprehensive stream pollution control program. The legislature renamed the program's study committee as the State Stream Sanitation Committee and designated the chief engineer of the State Board of Health as one of the committee's two ex officio members. Later in the decade, the 1957 General Assembly established the committee as a permanent body within the State Board of Health, and the state board created the Division of Water Pollution Control to provide support services.

In 1955 the General Assembly established within the state board a Committee on Postmortem Medicolegal Examinations with the state health officer as chairman. The chairman was authorized to appoint a qualified physician as medical examiner for each county, subject to the approval of the committee and that county's board of commissioners.

In 1956 the second Commission of the Reorganization of State Government studied administration of the state's water resources and noted overlapping jurisdictions among several state agencies. It recommended to the assembly that a Board of Water Commissioners be created to advise the executive and legislative branches on reorganization of the state's water resource agencies, including the State Stream Sanitation Committee and the Division of Water Pollution Control of the State Board of Health. The Board of Water Commissioners recommended that the Division of Water Pollution Control be abolished, but that the State Stream Sanitation Committee be transferred to a new Department of Water Resources with exclusive jurisdiction over stream classification until 1 July 1965. The legislature created the new agency, but also required that sewage disposal plans be approved either by the State Board of Health or by the State Stream Sanitation Committee.

For some time the disease of poliomyelitis had posed a significant health problem for the state and its health professionals, including the Division of Epidemiology and its Crippled Children Section. Methods of immunization that were developed during the 1950s prompted the state board in May 1958 to recommend compulsory immunization of young children. The General Assembly's response the following year made North Carolina the first state in the nation to require polio vaccinatons as a prerequisite for public school entry. In cooperation with county health departments, the state board played a significant role in the distribution of the vaccine.

In 1963 the General Assembly created a new Department of Mental Health, transferring to that department the services previously performed by the Division of Local Health and its Mental Health Section. Other laws during the same period significantly increased the state board's responsibilities. In 1961 the legislature provided for the licensing of nursing homes by the State Board of Health rather than by the Medical Care Commission and the State Board of Public Welfare. The 1963 General Assembly gave the state board responsibility for a program of air pollution control, although they failed to fund it. In 1965 Governor Dan K. Moore designated the State Board of Health as the official state agency to administer Title XVIII of U.S. Public Law 89-97, commonly referred to as Medicare. The Office of Chief Medical Examiner and a Division of Medical Examiner were created in 1967 with statewide responsibilities for providing autopsies (medicolegal examinations) and investigations in all unexplained deaths.

Following a study by the Governor's Commission on State Government Reorganization, the Executive Organization Act of 1971 moved the State Board of Health under a newly created umbrella agency, the Department of Human Resources (DHR). The DHR was headed by a cabinet-level secretary appointed by the governor and designated as the departmental secretary. Under terms of this act, the State Board of Health retained its previous statutory powers and duties. However, by the Executive Organization Act of 1973, the DHR and its secretary were charged with performing the executive functions of the state in relation to general health, as well as mental health and health rehabilitation. The State Board of Health and its governing authority ceased to exist.

Under the 1973 act, the Commission for Health Services was granted the power and duty to adopt rules and regulations for the conduct of the state's public health programs, to protect and promote public health, and to control diseases and other health impairments. Rules in effect under the old state board would remain until repealed or superseded by action of the Commission for Health Services and were to be enforced by DHR. The commission would continue to adopt health standards and regulations for nursing homes, restaurants, and lodgings, and for various other facilities around the state. Furthermore, the law stipulated that local health departments, when directed by the DHR, would enforce rules established by the Commission for Health Services and that DHR would supervise the local health departments.

Initially, the Commission for Health Services was composed of members of the old State Board of Health who finished their terms. Thereafter, the Commission for Health Services was to consist of four members elected by the North Carolina Medical Society and seven appointed by the governor, including a dairyman, and a licensed pharmacist, veterinarian, optometrist, and dentist. The governor was authorized to name one of the members as chairman to serve at his pleasure, while others served terms of four years. Separate legislation in 1973 enlarged the Commission for Health Services to include a registered nurse as one of the governor's appointees. The same legislature also authorized the Commission for Health Services to approve minimum sanitation standards for schools, although these were subject to adoption by the State Board of Education. The DHR was granted supervisory responsibility over the sanitary and health conditions of prisons and facilities under the jurisdiction of the Department of Correction. The Commission for Health Services, however, was charged with specific responsibility for rules promoting health and the control of disease in such facilities.

Following its 1973 reorganization, DHR implemented a series of administrative innovations and changes. Among these, the department established a new Division of Facility Services with a Licensing and Certification Section to administer the Medicare and Medicaid programs. Most of the other programs formerly under the State Board of Health were absorbed by the Division of Health Services.

Headed by the state health director, the Division of Health Services was responsible for administering the main components of the state's public health programs. Under it, many of the former divisions and sections of the old State Board of Health were reorganized as sections and branches. The Epidemiology Section under DHR was to consist of the following major branches: Communicable Disease Control, Occupational Health, Tuberculosis Control, Veterinary Public Health, Venereal Disease Control, and Highway Safety. In 1972, the Public Health Statistics Branch, formerly under the State Board of Health, split into Vital Records, which remained under Epidemiology, and the Public Health Statistics Branch, which moved to DHR's Administrative Services. The Sanitary Engineering Section had the following major branches: Water Supply; Sanitation; and Solid and Hazardous Waste Management. The former divisions of Laboratory, Dental Health, and Medical Examiner remained intact as sections under the Division of Health Services of DHR. The former Division of Community Health was reorganized as a section but was abolished by 1974. The Division of Personal Health, also reorganized as a section, was split in 1979 into two sections: Maternal and Child Care, and Health Assurance. By 1982 the latter section had been reorganized as the Adult Health Services Section and acquired relatively recent projects such as the Migrant Health Program and the Human Tissue Donation Program. The Maternal and Child Care Section included programs on Nutrition and Dietary Services, Perinatal Health, Developmental Disabilities, and Family Planning. Among the other changes during this period, the Sanitary Engineering Section was renamed the Environmental Health Section in 1979.

During the 1970s, the Division of Health Services had established an Office of Management Services to administer funds received through state and federal allocations and to advise local health departments on financial and program matters. Although the division held limited statutory authority over the operations of local health departments, it nevertheless influenced local operations through the process of allocating funds and monitoring contractual agreements between the local units and the state.

The 1979 General Assembly required DHR rather than the Commission for Health Services to approve plans for public water supply systems and certain categories of sewage systems. In 1981 the commission was authorized to adopt "by reference" all appropriate federal regulations or codes of other state or federal agencies, thus enabling it to adjust its rules in order to qualify for federal grants for public health purposes. In a separate act, the legislature changed the composition of the Commission for Health Services by replacing its member from the dairy industry with a soil scientist or a registered engineer experienced in sanitary engineering.

In 1988 the administration of Governor James G. Martin began work with the Legislative Study Commission on the Consolidation of Environmental Regulatory Agencies. The governor proposed combining the Division of Health Services from the DHR with the natural resources and environmental regulatory functions of the Department of Natural Resources and Community Development. Martin maintained that such a consolidation would strengthen both the health and environmental functions of state government. The General Assembly of 1989 enacted a law creating and organizing a new Department of Environment, Health, and Natural Resources (EHNR).

Under EHNR's enabling act, the Commission for Health Services, the Division of Health Services, and all their statutory powers and duties were placed under the authority of the new department and its secretary, a cabinet-level officer appointed by the governor. The secretary placed the former Division of Health Services and the state health director under the supervision of a deputy secretary for health and administration. The state health director was designated as the assistant secretary for state health and was given responsibility for the sections formerly under the Division of Health Services. These were reorganized as the following divisions: Adult Health Services; Dental Health Services; Environmental Health (Public Water Supply, Pest Management, Environmental Community Health); Epidemiology and Laboratory Services; and Maternal and Child Care. The Office of Post Mortem Medicolegal Examination, directed by the chief medical examiner, was placed administratively under the deputy for health and administration. New programs in place by the early 1990s included the Office of Chief Nurse, charged with coordinating public health nursing services with local health departments and statewide programs; the Office of Health Education, charged with providing various services and developing teaching strategies for environmental, community, and personal health programs; and the Office of Legislative Affairs to represent the department in the General Assembly and to monitor proposed legislation and the work of the legislative study and research committees.

Institute for Government Research of the Brookings Institution. REPORT ON A SURVEY OF THE ORGANIZATION AND ADMINISTRATION OF THE STATE GOVERNMENT OF NORTH CAROLINA. Washington, D.C., 1930. Pp. 176-190.

Long, Dorothy. "Organization of the North Carolina Medical Profession, 1799 and 1849." In MEDICINE IN NORTH CAROLINA: ESSAYS IN THE HISTORY OF MEDICAL SCIENCE AND MEDICAL SERVICE, 1524-1960, VOLUME I, edited by Dorothy Long. Raleigh: North Carolina Medical Society, 1972. Pp. 69-96.

McCain, Mrs. Paul P., and Mrs. John L. McCain. "Tuberculosis in North Carolina--Facilities for Its Treatment and Control." Chap. 16 in MEDICINE IN NORTH CAROLINA: ESSAYS IN THE HISTORY OF MEDICAL SCIENCE AND MEDICAL SERVICE, 1524-1960, VOLUME I, edited by Dorothy Long. Raleigh: North Carolina Medical Society, 1972. Pp. 313-329.

Mitchell, Memory F., ed. ADDRESSES AND PUBLIC PAPERS OF ROBERT WALTER SCOTT, GOVERNOR OF NORTH CAROLINA, 1969-1973. Raleigh: Division of Archives and History, Department of Cultural Resources, 1974. Pp. 83-90.

---, and Benjamin Drake. "History of Public Health in North Carolina." In MEDICINE IN NORTH CAROLINA: ESSAYS IN THE HISTORY OF MEDICAL SCIENCE AND MEDICAL SERVICE, 1524- 1960, VOLUME II, edited by Dorothy Long. Raleigh: North Carolina Medical Society, 1972. Pp. 581-622.

Office of the Secretary of State. DIRECTORY OF THE STATE AND COUNTY OFFICIALS OF NORTH CAROLINA: 1993. Compiled by Linda Wise. Raleigh, 1993. Pp. 46-47.

---. THE NORTH CAROLINA SANATORIUM FOR THE TREATMENT OF TUBERCULOSIS. Raleigh, [1914].

University of North Carolina at Chapel Hill. Institute of Government. BOARDS OF HEALTH IN NORTH CAROLINA: A GUIDEBOOK FOR BOARD MEMBERS, by Thomas W. Ross. Revised by Jacqueline B. Queen and Michael R. Smith. Chapel Hill, 1983. Pp. 1-7.

Washburn, Benjamin E. THE FIRST FIFTY YEARS OF ORGANIZED PUBLIC HEALTH WORK IN NORTH CAROLINA: A HISTORY OF THE STATE BOARD OF HEALTH: 1877-1925. Raleigh: North Carolina State Board of Health, 1966.

Zimmerman, Jane. "The Formative Years of the North Carolina Board of Health, 1877-1893." NORTH CAROLINA HISTORICAL REVIEW 21, no. 1 (1944) 1-34.